Surrogacy

Background

Since 2010 Clemence Due and I have been writing on the topic of surrogacy. Our initial research in the field focused on Australian news media and parliamentarian debates on the topic. More recently we have also undertaken interviews with Australian parents (gay and heterosexual) who had undertaken an offshore commercial surrogacy arrangement (in India or the US). We brought together our work on surrogacy in a book: A Critical Approach to Surrogacy: Reproductive desires and demands (2018, Routledge). I have also written with Deborah Dempsey, where we explored gay men’s accounts of pregnancy in the context of surrogacy arrangements.

I have also written a piece for The Conversation on the topic of surrogacy. I have recently contributed to a new Australian Psychological Society information sheet on gay men and surrogacy, available here.

A full list of my research publications can be found further down the page, and are drawn on in the applications of research findings sections below.

In Australia, only altruistic surrogacy is legal, where no payment is made to the woman other than to cover her out-of-pocket expenses including medical bills. However, very few surrogacy arrangements take place onshore in Australia, with most occurring offshore. Offshore surrogacy arrangements are often commercial, with Australians engaging in commercial surrogacy primarily in the US. Laws relating to surrogacy are frequently changing and differ between states and territories in Australia.

Applications of research findings for specialists in clinics

The research findings indicate that intending parents entering into (commercial) surrogacy arrangements are likely to do a significant amount of their own research (including in relation to selecting agencies and clinics, selecting surrogates and egg donors, if required, and reading about other people’s experiences), yet this still does not fully prepare them for the experiences and challenges of undertaking surrogacy. In particular, the findings show that intending parents experience clinics as viewing surrogacy as a clinical transaction, which largely ignores the emotional processes for those involved. The findings suggest that specialists working in the area of surrogacy need to provide more transparent information about the process of surrogacy, and better prepare intending parents for challenges that may occur. One example of this from the research findings is the need for specialists to make intending parents aware that pregnancy loss is a possibility, and that if this does occur, specialists need to support intending parents (and surrogates) around this, rather than rushing them into trying again. The findings particularly indicate that clinics need to offer counselling for intending parents, so they can better cope with any potential challenges.

In addition, the research findings also highlight that a diverse range of people pursue surrogacy, for a wide range of reasons. This suggests that specialists and clinics need to provide services which are inclusive of all family forms (e.g. individuals and couples, heterosexual and same-sex relationships) with different backgrounds and experiences. The findings suggest that gay men’s desires for parenthood are not necessarily viewed as being as significant or strong as heterosexual people’s desires for parenthood. This suggests it would be useful for specialists to more empathetically take into account people’s desires to have a child, and their likely difficulties to have children via other means (including in relation to medical or social infertility). In addition, as the research findings show, specialists need to more fully explore with intending parents why surrogacy is desired and whether it is the best option for them. This is particularly important in light of the research findings which show that people pursuing surrogacy arrangements value being genetically related to their children (and have a desire to have children in the first place), which is a reflection of dominant social norms and privilege.

Applications of research findings for (intending) parents and families

The research findings show that intending parents who enter into surrogacy arrangements often frame this as their only or last option to have children, due to social infertility (e.g. in the case of gay men or single people), or medical infertility (e.g. in the case of heterosexual women who cannot carry a child). At the same time, the findings suggest that surrogacy may be preferred to other options which could be pursued (such as foster care and adoption) due to the significance that people place on genetic relatedness and the view that a genetic child is more ‘permanent’ than fostering or adopting a child. In arguing this, research participants tended to negatively portray modes of family formation where parents and their child(ren) were not genetically related. These research findings suggest it is useful for intending parents to think through the significance of genetic relatedness and, if it is important to them in building a family, why this is the case. In particular, it may be useful to reflect on whether having a genetically related child is important to them beyond the fact that this is a normative or culturally privileged way of having a child.

The findings also highlight that while intending parents may be aware that there are many children who need foster parents, undertaking surrogacy is constructed as the only possible choice. Similarly, media representations of surrogacy arrangements also draw on perspectives of parents who privilege surrogacy over other forms of parenthood (e.g. foster care or adoption) and view surrogacy as a more straightforward process, which can gloss over the difficulties and challenges involved in surrogacy arrangements, particularly when they take place offshore. Again, these findings encourage reflection on the meaning of parenthood and having children, as well as more thoroughly exploring a broad range of options for ways of becoming a parent, if this hasn’t already been pursued.

As might be expected, the research findings indicate that clinics are unlikely to suggest intending parents should think about whether surrogacy is the best way for them to have children. This suggests that it is important for people considering surrogacy to think through why they have chosen this option and to seek support in making this decision from outside clinics and other places which benefit if surrogacy arrangements are undertaken.

The research findings suggest that intending parents do not always find clinics supportive and informative about the surrogacy process, and that challenges relating to surrogacy are often downplayed. These findings suggest that intending parents need to be more aware of the challenges involved in surrogacy, such as the potential for pregnancy loss and the complications of offshore surrogacy (such as the difficulties of distance and the intricacies of collecting the child and bringing them back to Australia). It is important to remember that for clinics surrogacy is a financial transaction, which is likely to be very different to how intending parents view the arrangement, particularly in terms of the emotional investments in having a child.

In addition, the interview findings suggest that there is a general lack of post-birth support from clinics. Similarly, the findings relating to media reports about Australians undertaking surrogacy offshore tend to portray intending parents as initially vulnerable (due to infertility) and then having agency as they undertake surrogacy and ‘solve’ the ‘problem’. However, these reports miss the ongoing challenges that parents are likely to face, both in terms of challenges that all parents may face when raising children and those specific to parenting after undertaking offshore surrogacy. These findings suggest that it is very important for intending parents to focus further ahead than just on the birth of the baby. In particular, it may help to seek further support, including in terms of caring for a newborn baby and adjusting to parenthood, from sources outside clinics.

The research findings show it can be useful to think through the implications for all those involved in the surrogacy process. In particular, the findings suggest that intending parents were mostly focused on their own needs, rather than other people’s needs, such as those of the surrogate. For example, the interview findings suggested that intending parents who undertook surrogacy arrangements in India framed the surrogacy arrangement as financially benefitting the surrogate and tended not to consider the impacts that surrogacy may have on surrogates (such as how it may fit with their family and religion, the impact on their own families, the impact on their own reproductive health, and the impact on their psychological health). It is therefore important for intending parents to reflect on how they view the process of surrogacy, including how they view the surrogate and the financial transactions that take place, and whether they are comfortable with these arrangements. It is also important to consider their own position of privilege in a capitalist market.

The research findings in relation to the analysis about picture books featuring surrogacy reinforce the norm of parents and children being genetically related, and view this connection as privileged over other parent/child connections. In other words, the books portray parents and children being genetically related as the most desirable way of forming a family. The books also tend to frame surrogates as ‘kindly strangers’ who ‘return’ children to their parents. As these books explain surrogacy in narrow ways to children, it may help to find more books which offer different explanations of surrogacy, and to more broadly talk about the diversity of family forms with children, without privileging certain forms over others.

Crawshaw, M., Purewal, S., & Van den Akker, O. (2013). Working at the margins: The views and experiences of court social workers on parental orders’ work in surrogacy arrangements. British Journal of Social Work, 43(6), 1225-1243.